PubMed · 14712784
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Katherine Hobson. 2003-12-22. Joint decisions.. https://pubmed.ncbi.nlm.nih.gov/14712784/
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We describe a case of spontaneous dissociation of the metal inlay from the polyethylene cup of a sandwiched metal-on-metal total hip prosthesis manufactured from Co-28Cr-6Mo SM 21 alloy. The patient, a 51-year-old active woman, started to feel groin pain 50 months postoperatively. The pain progressed after a slight trauma and led to final revision after 66 months in situ. No signs of impingement were observed. The polyethylene cup showed an approximately 2 mm-deep groove in the superior wall, and the head was heavily worn on the lateral side. In addition to the typically observed abrasive wear patterns, several types of severe wear defects were noticed. Extensive metallosis and necrosis were observed histologically. This unusual case of substantial deformation of the head and the cup was presumed to have occurred as a result of the increased friction and consequent high wear of the metal head.
BACKGROUND: Clinically unrecognized thrombosis with the danger of a pulmonary embolism represents an underestimated problem in surgical ICU patients. In patients undergoing total hip replacement for instance, over 30% develop a clinically inapparent form of thrombosis, despite initial thrombosis prophylaxis. We tried to recognize clinically inapparent thrombosis in long-term intensive care patients using D-dimer screening and ultrasound imaging. METHODS: All surgical long-term ICU patients received intravenous heparin 5-10 IU/kg body weight and a D-dimer was assay was carried out every 2 days. If the D-dimer level surpassed 2 mg/l, ultrasound imaging of the veins in the legs, pelvis, arms and neck was performed. RESULTS: Included in the study were 50 patients and D-dimer levels above 2 mg/l were detected in 38%. A thrombosis was proven in 63% of the patients with D-dimer values above 2 mg/l and 50% of the thrombosis were detected in the arm and neck veins very often associated with intravenous catheters. CONCLUSION: Routine D-dimer screening and specific use of ultrasound imaging appears to be a valuable method to verify clinically inapparent thromboses in surgical ICU patients.